Provider Demographics
NPI:1841544657
Name:THE CENTER FOR PSYCHOTHERAPY AND RESILIENCY LLC
Entity type:Organization
Organization Name:THE CENTER FOR PSYCHOTHERAPY AND RESILIENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYELET
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAVDA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:781-775-0540
Mailing Address - Street 1:82 WOBURN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-2224
Mailing Address - Country:US
Mailing Address - Phone:781-775-0540
Mailing Address - Fax:
Practice Address - Street 1:393 MASS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-6701
Practice Address - Country:US
Practice Address - Phone:617-352-0791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty